MRI-based brain volumetry in chronic whiplash patients: no evidence for traumatic brain injury

• Published in: Acta neurologica Scandinavica Vol. 117; no. 1; pp. 49 - 54
• Main Authors: Sturzenegger, M., Radanov, B. P., Winter, P., Simko, M., Farra, A. D., Di Stefano, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2008; Blackwell
• Subjects: Adult; Alcoholism and acute alcohol poisoning; Atrophy - etiology; Atrophy - pathology; Atrophy - physiopathology; Biological and medical sciences; Brain - pathology; Brain - physiopathology; Brain Injuries - pathology; Brain Injuries - physiopathology; Brain Injuries - psychology; Chronic Disease; Cognition Disorders - etiology; Cognition Disorders - pathology; Cognition Disorders - physiopathology; cognitive complaints; Comorbidity; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lateral Ventricles - pathology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; mild traumatic brain injury; Nervous system; Neurology; Organ Size; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Predictive Value of Tests; Sensitivity and Specificity; Toxicology; VBR; Whiplash Injuries - complications; Whiplash Injuries - physiopathology; Whiplash Injuries - psychology; whiplash injury; Human; cognitive complaints; Chronic; Nervous system diseases; Coup de fouet syndrome; Central nervous system; VBR; Head trauma; whiplash injury; Nuclear magnetic resonance imaging; mild traumatic brain injury; Encephalon
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/j.1600-0404.2007.00939.x

Introduction –  Cognitive complaints, such as poor concentration and memory deficits, are frequent after whiplash injury and play an important role in disability. The origin of these complaints is discussed controversially. Some authors postulate brain lesions as a consequence of whiplash injuries. Potential diffuse axonal injury (DAI) with subsequent atrophy of the brain and ventricular expansion is of particular interest as focal brain lesions have not been documented so far in whiplash injury. Objective –  To investigate whether traumatic brain injury can be identified using a magnetic resonance (MR)‐based quantitative analysis of normalized ventricle–brain ratios (VBR) in chronic whiplash patients with subjective cognitive impairment that cannot be objectively confirmed by neuropsychological testing. Materials and methods –  MR examination was performed in 21 patients with whiplash injury and symptom persistence for 9 months on average and in 18 matched healthy controls. Conventional MR imaging (MRI) was used to assess the volumes of grey and white matter and of ventricles. The normalized VBR was calculated. Results –  The values of normalized VBR did not differ in whiplash patients when compared with that in healthy controls (F = 0.216, P = 0.645). Conclusions –  This study does not support loss of brain tissue following whiplash injury as measured by VBR. On this basis, traumatic brain injury with subsequent DAI does not seem to be the underlying mechanism for persistent concentration and memory deficits that are subjectively reported but not objectively verifiable as neuropsychological deficits.